PANCE Blueprint Dermatology (5%)

PANCE Blueprint Dermatology (5%)

PANCE Blueprint Dermatology (5%)

Follow along with the NCCPA™ PANCE AND PANRE Dermatology Content Blueprint

  • 66 Question Comprehensive Dermatology Exam
  • Dermatology Pearls Flashcards
  • Dermatology Pearls high yield summary tables
  • ReelDX™ integrated video content (available to paid subscribers)


  1. Dermatology Comprehensive Exam (Members Only)

  2. Dermatology Flashcards (Members Only)

  3. Acneiform Eruptions (PEARLS)

    1. Rosacea

      • Differentiate from acne by lack of comedones (blackheads)
      • Treatment is topical metronidazole
    2. Folliculitis

      Folliculitis is an infection of one or more of the hair follicles (pockets from which hair grows) characterized by papules and pustules
      • The lesions are erythematous papules or pustules. They are usually not painful but may burn
      • Commonly caused by S. aureus but can be caused by other organisms. Pseudomonas folliculitis is seen in hot tub users
      • Mupirocin ointment and topical benzoyl peroxide cream are first-line
      • In more extensive cases, oral antibiotics may be necessary - dicloxacillin and cephalexin. If methicillin-resistant S. aureus is suspected, patients should be treated with trimethoprim/sulfamethoxazole, clindamycin, or doxycycline
  4. Desquamation (PEARLS)

    3. Toxic epidermal necrolysis

  5. Disorders of the Hair and Nails (PEARLS)

    1. Alopecia (ReelDx)

    2. Onychomycosis

    3. Paronychia (ReelDx)

  6. Envenomation and arthropod bite reactions (ReelDx)

    1. Erythema infectiosum (ReelDx)

      Erythema infectiosum is caused by parvovirus B-19
      • Slapped cheek rash on the face with circumoral pallor 2-4 days of lacy reticular rash on extremities
      • Diagnosis is clinical and treatment is symptomatic
    2. Hand Foot and Mouth Disease

      Children < 10 years old caused by coxsackievirus type A virus producing sores in the mouth and a rash on the hands, feet, mouth, and buttocks  (watch video)
      • The virus usually clears up on its own within 10 days
      Treatment is supportive, anti-inflammatories
    3. Measles

      Measles is caused by a paramyxovirus and is transmitted by respiratory droplets, it has a 10-12 day incubation period. It progresses in three phases characterized by a prodrome, enanthem, and exanthem.
      • Prodrome: 1-3 days of a "the three C's" - cough, coryza, conjunctivitis, as well as fever.
      • Enanthem (48 hours prior to exanthem) Koplik spots - are pathognomonic for measles and present as small red spots with a blue-white center on the buccal mucosa.
      • Exanthem (2-4 days after onset of fever): consists of a morbilliform, brick red erythematous, maculopapular, blanching rash, which classically begins on the face and spreads cephalocaudally and centrifugally to involve the neck, upper trunk, lower trunk, and extremities.
      • Treatment is supportive with anti-inflammatories.
  7. Dermatologic Infectious diseases (PEARLS)

      1. Cellulitis (ReelDx)

      2. Erysipelas

        • Almost always caused by streptococcus pyogenes
        • Treated with Penicillin G
      3. Impetigo (ReelDx)

    1. Fungal Infections (PEARLS)

      1. Candidiasis (ReelDx)

      2. Dermatophyte Infections (ReelDx)

        KOH - long, branching fungal hyphae with septations
        • Tinea Barbae: papules pustules, around hair follicles
      1. Lice (ReelDx)

      2. Scabies (ReelDx)

    2. Viral Dermatologic Diseases (PEARLS)

      1. Condyloma acuminatum (genital warts)

      2. Herpes simplex (ReelDx)

        • HHV 7 - Similar to HHV6 (not yet classified)
      3. Molluscum contagiosum (ReelDx)

        Molluscum contagiosum: caused by the poxviruspearly papules with central umbilication
      4. Varicella-zoster virus infections (ReelDx)

      5. Verrucae


  8. Keratotic disorders (PEARLS)

    1. Actinic keratosis

    2. Seborrheic keratosis

  9. Dermatologic Neoplasms (PEARLS)

    1. Basal cell carcinoma

    2. Kaposi sarcoma

    3. Melanoma

    4. Squamous cell carcinoma

  10. Papulosquamous Disorders (PEARLS)

    1. Drug eruptions (ReelDx)

    2. Lichen planus

    3. Pityriasis rosea (ReelDx)

    4. Psoriasis (ReelDx)

  11. Pigment disorders (Pearls)

    1. Melasma

    1. Burns (ReelDx)

      Body percentage:
      • Palmar method: Patient’s palm equates to 1%
      Degree involvement:
    2. Lacerations

      Suture removal — The timing of suture removal varies with the anatomic site
      • Eyelids – Three days
      • Neck – Three to four days
      • Face – Five days
      • Scalp – 7 to 14 days
      • Trunk and upper extremities – Seven days
      • Lower extremities – 8 to 10 days
    3. Pressure ulcers

      Sacrum and hip most often affected, reposition every 2 hours
    4. Stasis dermatitis

      Stasis dermatitis is caused by fluid buildup due to varicose veins, poor circulation, or heart disease
      • Skin discoloration of the ankles or shins, itching, thickened skin, and open sores (ulcers) are symptoms
      • Treatments may include compression stockings and corticosteroid creams as well as treating the underlying condition
      • Systemic antibiotics for patients with more extensive infection and signs of cellulitis
  12. Vascular abnormalities (PEARLS)

    1. Cherry angioma

      Red moles, or cherry angiomas, are common skin growths that can develop on most areas of the body. The collection of small blood vessels inside a cherry angioma give them a reddish appearance
      • They're also known as senile angiomas or Campbell de Morgan spots
      • They're usually found on people aged 30 and older
      These lesions generally do not require treatment
      • If they are cosmetically unappealing or are subject to bleeding angiomas may be removed by electrocautery or pulsed dye laser treatment
    2. Telangiectasia

      Dilated small blood vessels on the skin or mucous membranes, anywhere in the body
  13. Vesiculobullous disease (PEARLS)

    1. Bullous pemphigoid

    2. Pemphigus Vulgaris

      Pemphigus vulgaris (PV) is a potentially fatal autoimmune blistering disease characterized by painful mucocutaneous lesions and a positive Nikolsky sign (extension of blister or sloughing of skin with blunt pressure or lateral traction of skin)
      • Autoantibodies (IgG) against desmosome which  disrupts keratinocyte adhesion and separation of the epidermis
      • Nonhealing and nonscarring ulcers persisting for at least 1 month, extremely painful, fragile blisters from mouth to elsewhere
      • Most common in those of Mediterranean or Jewish descent 40-60 years of age
      • Immunofluorescence of serum or blisters material highlights intercellular deposition of IgG or C3 in net-like (reticular) pattern
        • Biopsy proves acantholysis (separation of epidermal cells)
      • Systemic therapy is required. Start with oral prednisone, and then add immunosuppressive agents, azathioprine, and/ or methotrexate as needed
  14. Other Dermatological Disorders (PEARLS)

    1. Acanthosis nigricans (ReelDx)

    2. Hidradenitis suppurativa

    3. Lipomas/epithelial inclusion cysts

    4. Photosensitivity reactions

      • Solar urticaria develops at a site of sun exposure within a few minutes. Lesions generally resolve within 24 hours
      • Chemical photosensitivity is a cutaneous reactions after sun exposure after ingestion or topical application substance (ex. isotretinoin and amiodarone)
      • Polymorphous light eruption is a common photosensitive reaction to UV and sometimes visible light not associated with systemic disease or drugs
      • Phototesting can help confirm the diagnosis
      • Avoid overexposure to sun, wear protective clothing, use sunscreens (prevention), topical corticosteroids, H1 blockers
      • Stop drugs or chemicals that cause photosensitivity
      • For polymorphous light eruption, other specific treatments include immunosuppressive therapy such as prednisone, azathioprine, cyclosporine, or hydroxychloroquine
    5. Pilonidal disease

    6. Urticaria (ReelDx)

    1. Dyshidrosis (ReelDx)

    2. Lichen simplex chronicus


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